In case you missed them, here are our top 5 articles for the week of May 7, 2017.
The Top 5 articles this past week brought attention to serious issues impacting public health today, such as a growing measles outbreak in Minnesota, and measures that are being taken in the US government to stop the growing issue of antibiotic resistance. In addition, we provided an article focused on a new discovery recently made by University of North Carolina researchers on a potential new target for HIV therapies. Highlights of the recommended antibiotic recommendations in the recent Infectious Disease Society of America and the American Thoracic Society guidelines for treating nosocomial pneumonia are included in our #2 article of the week; and finally, our top article of the week is an insights piece that showcases expert commentary on just how close we are to curing HIV.
Learn more about our top 5 articles of the week, below:
The state of Minnesota continues to battle its largest measles outbreak in decades and officials have linked the outbreak to “a sharp decline in vaccination rates in a local Somali community.”
According to health officials, 48 cases of infection have been reported as of May 9, 2017. A total of 45 of these individuals had not received the measles, mumps, rubella (MMR) vaccine and 41 of the 48 individuals who are infected are members of a Somali community in the state. Although these numbers may not seem very high, to put it into perspective, prior to this outbreak, Minnesota saw “a total of 56 cases, either imported cases or linked to imported cases, in the last 20 years combined.”
The Minnesota Department of Health (DOH) was quick to assure the public that this outbreak is not directed at a specific community, but rather at the practice of not vaccinating children. In a statement released by the Minnesota DOH, Minnesota Health Commissioner Ed Ehlinger, MD, MSPH, stated, “This is about unvaccinated children, not specific communities. There are people of all backgrounds around the state who have chosen not to protect themselves or their children. Often, that decision is based on good intentions and inaccurate information. It’s the responsibility of all of us who care about the health of Minnesota children to make sure people have accurate information and take action to protect their families and their communities.”
Currently, the outbreak has spread across 3 counties (Hennepin, Ramsey, and Crow Wing).
Learn more about the Minnesota measles outbreak here.
Contagion® Editorial Advisory Board member, John Mohr, PharmD, and colleagues weighed in on what Congress is doing to tackle the threat of antibiotic resistance in this week’s fourth top article of the week. Because of an increase in antibiotic resistance and the fact that bacteria continue to evolve, the development of new antibiotics to combat these issues is paramount. Although current development measures have, “fallen far behind the rising incidence of antibiotic-resistant infections,” an approval pathway for new antibiotics “intended to treat serious and rare pathogens,” may encourage new research. The approval pathway, dubbed the Limited Population Antibacterial Drug (LPAD) regulatory pathway is included in a law signed by President Barack Obama in December 2016: the 21st Century Cures Act (Cures Act).
The LPAD regulatory pathway “provides the FDA flexibility in the approval of antibiotics intended for limited patient populations,” by potentially allowing for “smaller descriptive clinical datasets supplemented by robust nonclinical data.” In addition, among other directions, the “LPAD directs the FDA to consider the benefit—risk profile in the intended population, the availability of alternative treatment options, and the severity and rarity of the infection that the antibiotic is intended to treat.”
In addition to LPAD pathway, the Cures Act encourages increased efforts to reduce the inappropriate use of antibiotics, as well as widespread monitoring of antibiotic resistance. Healthcare facilities and organizations across the country will be provided with the necessary mechanisms to appropriately monitor antibiotic resistance and implement antibiotic stewardship programs. Their findings will be reported annually, and trends and progress will be tracked. The first report is expected later this year.
Read more about how the 21st Century Cures Act could impact antibiotic resistance here.
New discoveries continue to be made about HIV. Indeed, recently, researchers from the Division of Infectious Diseases at the University of North Carolina (UNC) School of Medicine have found that the virus does not only infect T cells, but it also persists in macrophages. According to a UNC press release, “The discovery of this additional viral reservoir has significant implications for HIV cure research,” because the study results demonstrate that new therapies against the virus may have to target “two very different types of cells.”
Although the researchers demonstrated that macrophages are capable of being infected with HIV, they also discovered that the macrophages responded to antiretroviral therapy. They also showed that “productively infected macrophages can persist despite ART; and most importantly, that they can reinitiate and sustain infection upon therapy interruption even in the absence of T cells—the major target of HIV infection.”
More about this recent discovery is available here.
Contagion® Editorial Advisory Board member, Khalid Eljaaly, PharmD, BCPS, CAPP, highlighted recent changes in recommended treatment guidelines for nosocomial pneumonia in our #2 article of the week. More than a decade has passed since the first guidelines, jointly developed by the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS), were published and Dr. Eljaaly focuses on updates related to antibiotic therapy recommendations.
One difference highlighted in the article is that healthcare-associated pneumonia (HCAP) is now included under the guidelines for community-acquired pneumonia because new research has shown that “many patients are not at high risk for multidrug-resistant (MDR) organisms as previously thought and therefore should not be treated in the same manner as patients with hospital-acquired pneumonia (HAP) or ventilator-acquired pneumonia (VAP).” Additional risk factors for MDR pathogens are provided in the new guideline.
Also included are are recommended empiric coverage of Methicillin-sensitive Staphylococcus aureus, in VAP, which was not included in the previous version, as well as the suggestion that procalcitonin plus clinical criteria guides antibiotic discontinuation.
Read the full update to the IDSA / ATS Guidelines here.
Contagion® freelance writer, Laurie Saloman, MS, recently spoke with top experts in the field to discuss the strides we have made with treating HIV.
Once a death sentence, an HIV diagnosis now means that an individual can expect to live a long life, albeit one with a daily medication requirement. Treatment has come a long way from the multidrug “cocktails’ of the 1990s and 2000s, however. Renowned HIV researcher, Paul Volberding, MD, a professor at the School of Medicine of University of California, San Francisco, told Contagion®, “All of us who are educators and [gave] lectures to groups used to have in our slide collections [photos of] 2 handfuls of pills,” referring to the unwieldy treatment regimen that was the standard of care years ago.
The disease can now be controlled with 1-pill, once a day, but how close are we to a cure? According to the experts, “We’re getting there.” HIV expert, Roger Shapiro, MD, MPH, an associate professor at Harvard School of Public Health in Boston told Contagion®, “Ongoing research is now exploring how to push treatment even further and control the virus with longer-acting treatment or… approaches such as monoclonal antibodies—but we are not there yet.” Nevertheless, treatment methods have improved and the side effects that once plagued patients (such as diarrhea and nerve damage) are now well-controlled. This has spurred renewed optimism that we are well on our way to a cure.
Some large obstacles remain; however, such as a commitment to testing and adherence to the daily medication routine. According to Dr. Volberding, even as inroads are made as far as treatment is concerned, “[Certain] people don’t want to be tested. Men especially don’t want to be tested.” What’s more, “young people don’t want to take pills.” Even if individuals commit to taking the pills, it can still be a heavy burden.
“Some people just get weary of taking medication every day,” long-time HIV researcher, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases told Contagion®, while also pointing out that the side effects of treatment (in the form of antiretroviral therapy) can be toxic.
Continue reading about how close we are to a cure for HIV, here.